title: Cluster headache: potential options for medically refractory patients (when all else fails).
abstract: The most evidence exists for mixed anesthetic/steroid occipital nerve blocks (which are also useful in non-refractory patients), deep brain stimulation, sphenopalatine ganglion (SPG) blocks, SPG radiofrequency ablation, and SPG stimulation with the Autonomic Technologies, Inc (ATI) SPG Neurostimulator, the latter approved in the European Union and reimbursed in several countries.
authors.affiliation: Headache Center, Neurological Center for Pain, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Stewart J
authors.initials: SJ
authors.lastname: Tepper
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Stillman
mesh_terms: D003027:Cluster Headache / Q000175:diagnosis* / Q000628:therapy*; D046690:Deep Brain Stimulation / Q000379:methods; D006801:Humans; D008550:Melatonin / Q000627:therapeutic use; D009407:Nerve Block / Q000379:methods; D010148:Intractable Pain / Q000175:diagnosis* / Q000628:therapy*; D017211:Treatment Failure; D055536:Vagus Nerve Stimulation / Q000379:methods
chemical_list: D008550:Melatonin
keywords: LSD; cluster headache; neuromodulation; occipital nerve block; sphenopalatine ganglion stimulation; vagal nerve stimulation